Treatment

Seek expert advice.

Praziquantel

• is the drug of choice and is active against all schistosome species
• acts within one hour of ingestion
• can be used to treat young children (>4 years old) and pregnant women if breastfeeding is discontinued on the day of treatment and for the next 72 hours
• dose
  • S haematobium, S mansoni, S intercalatum - 40 mg/kg per day, two doses a day by mouth
  • S mekongi - 60 mg/kg per day, three doses a day by mouth
• resistance to the praziquantel has been reported in Africa due to heavy exposure to the drug

Adjuvant therapy

• corticosteroids
  • prednisone 1.5-2.0 mg/kg per day for three weeks is used for treatment of
    • Katayama syndrome within two months of freshwater contact
    • schistosomal encephalopathy during the oviposition (egg laying) stage
  • together with anticonvulsants corticosteroids may be used as adjuvants to praziquantel in neuroschistosomiasis,
  • help to alleviate acute allergic reactions and to prevent mass effects caused by excessive granulomatous inflammation in the CNS (1).
• anticonvulsant
  • used for seizures seen in cerebral schistosomiasis (lifelong use is rarely indicated)

Other antiparasitic agents

• oxamniquine - for S mansoni (not effective against S japonicum)
• metrifonate - for S haematobium (not effective against S japonicum)
• mefloquine-artesunate - has shown promising results against S haematobium but further investigations are necessary

Chemoprophylaxis

• praziquantel cannot be used for chemoprphylaxis since it is ineffective against chistosomula (migrating larvae) that are three to 21 days old
• artemethe
  • effective against juvenile schistosomes during the first 21 days of infection in animals and humans
  • all immature schistosomula should be killed if given every two weeks
  • efficacy of artemether based combination therapy is unclear

Reference:

• (1) Gray DJ et al. Diagnosis and management of schistosomiasis. BMJ. 2011;342:d2651.